Tubular laminectomy and percutaneous vertebroplasty for aggressive vertebral hemangioma.

BACKGROUND: Vertebral hemangiomas (VH) are the most common benign vascular neoplasms of the spine. Aggressive VH (AVH) may become symptomatic due to soft-tissue expansion/extraosseous extension into the paraspinal and/or epidural spaces. There are several options for treating painful AVH, including radiotherapy and/or open surgery. CASE DESCRIPTION: A 59-year-old male presented with a 2-year history of intermittent back pain and progressive thoracic myelopathy in the past 2 months. MRI revealed a T9 level lesion, with high-intensity signal on both T1 and T2 images and an extraosseous component with significant cord compression. We performed minimally invasive tubular unilateral laminotomy for bilateral decompression of the thoracic spine at the T9 level, followed by bilateral percutaneous vertebroplasty with biopsy. Postoperatively, the pain was immediately relieved, and the myelopathy improved. The biopsy confirmed the diagnosis of a VH. CONCLUSION: Combining minimally invasive techniques consisting of tubular laminectomy and percutaneous vertebroplasty are safe and effective ways for treating AVHs.

Minimally Invasive Tubular Tethered Cord Release in the Pediatric Population.

BACKGROUND: Tethered cord syndrome (TCS) refers to a clinical constellation of signs and symptoms associated with tension in the spinal cord and associated with pathologies related to abnormally low-lying conus medullaris. As minimally invasive spinal operations have become more prevalent in the past decade, we applied expanding indications to selected intradural procedures, such as tethered cord release (TCR). We present the first series of minimally invasive muscle-sparing TCR in the pediatric population. METHODS: A retrospective review of the Texas Children's Hospital, Houston, neurosurgical database was conducted for patients who underwent TCR between 2010 and 2017. Charts were reviewed to determine the source of TCS and whether surgery was conducted in a minimally invasive fashion. To establish a cohort of control population, age-matched cases of open TCR were selected in the same. Exclusion criterion was non-fatty filum sources of TCS. The length of stay, operative time, estimated blood loss, and postoperative complications were recorded. RESULTS: Eleven patients underwent minimally invasive TCR. Mean age of the patients was 10.1 years. All patients underwent L4-5 tubular laminotomy and cord detethering by 2 pediatric neurosurgeons at Texas Children's Hospital. The average length of stay in the hospital was 2.6 days. The average operative time was 167 minutes and average estimated blood loss was 8.2 mL. Ten patients reported clinical improvement and 1 patient was lost to follow-up. CONCLUSIONS: Minimally invasive TCR is a safe and represents a viable alternative to the open approach with advantages such as minimal estimated blood loss, shortened length of stay, and postoperative pain control.